Gokce Biricik M, Ozkose Zerrin, Tuncer Bilge, Pampal Kutluk, Arslan Derya
Department of Anesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey.
Saudi Med J. 2007 Mar;28(3):358-63.
To compare hemodynamics, recovery profiles, postoperative side effects and costs of desflurane-remifentanil and propofol-remifentanil anesthesia for septorhinoplasty operations.
A prospective and randomized study was carried out at the Gazi University Hospital, Ankara, Turkey from April to September 2003. Forty patients undergoing septorhinoplasty operations were randomly allocated to receive desflurane-remifentanil (Group DES-REM) or total intravenous anesthesia (TIVA) (Group TIVA). Anesthesia was induced in both groups with remifentanil 1 microg x ml (-1), propofol 2-2.5 mg.kg-1 and pancuronium 0.1 mg.kg-1. Maintenance was achieved with O2 50% in air at 4 L.min-1 and infusion of remifentanil 0.1 microg x ml (-1).min-1 in both groups. Group DES-REM received desflurane at 1 minimum alveolar concentration and Group TIVA received 10-4 mg.kg-1.hour-1 of propofol. Propofol infusion and desflurane were discontinued with the last surgical stitches, but remifentanil infusion continued in both groups until the nose was covered with plaster. Hemodynamic variables were recorded during the operation and one hour postoperatively in 5 min intervals. We recorded time of extubation, spontaneous eye opening and response to verbal commands times, visual analog scale pain scores, postoperative nausea and vomiting and Aldrete Recovery Score. Drug dosages and costs of each technique were determined.
There were no statistically significant differences between the groups with respect to hemodynamic parameters, recovery profile, adverse effects, Aldrete Recovery Score and cost analysis. Visual analog scale at 5 min postoperatively was higher in group desflurane-remifentanil compared to group propofol-remifentanil (p<0.05).
Both desflurane-remifentanil and TIVA provide perioperative hemodynamic stability, early and easy recovery with similar cost profiles for septorhinoplasty operations.
比较地氟醚-瑞芬太尼麻醉与丙泊酚-瑞芬太尼麻醉用于鼻中隔成形术的血流动力学、恢复情况、术后副作用及费用。
2003年4月至9月在土耳其安卡拉的加齐大学医院进行了一项前瞻性随机研究。40例行鼻中隔成形术的患者被随机分配接受地氟醚-瑞芬太尼（地氟醚-瑞芬太尼组）或全静脉麻醉（TIVA组）。两组均用1微克/毫升的瑞芬太尼、2-2.5毫克/千克的丙泊酚和0.1毫克/千克的潘库溴铵诱导麻醉。两组均以4升/分钟的流量吸入含50%氧气的空气，并输注0.1微克/毫升·分钟的瑞芬太尼以维持麻醉。地氟醚-瑞芬太尼组吸入1个最低肺泡浓度的地氟醚，TIVA组输注10-4毫克/千克·小时的丙泊酚。最后一针手术缝线缝合完毕后停止输注丙泊酚和停用七氟醚，但两组均继续输注瑞芬太尼直至鼻部用石膏覆盖。术中及术后1小时每隔5分钟记录血流动力学变量。记录拔管时间,自主睁眼时间和对语言指令的反应时间、视觉模拟评分法疼痛评分、术后恶心呕吐及Aldrete恢复评分。确定每种技术的药物剂量和费用。
两组在血流动力学参数、恢复情况、不良反应、Aldrete恢复评分和费用分析方面无统计学显著差异。术后5分钟时，地氟醚-瑞芬太尼组的视觉模拟评分高于丙泊酚-瑞芬太尼组（p<0.05）。
地氟醚-瑞芬太尼麻醉和TIVA麻醉均能为鼻中隔成形术提供围手术期血流动力学稳定、恢复早且容易，费用情况相似。
